Bridge-to-surgery versus emergency surgery in the management of left-sided acute malignant colorectal obstruction — Efficacy, safety and long-term outcomes. Issue 3 (March 2019)

• Record Type: Journal Article
• Authors: Rodrigues-Pinto, Eduardo; Morais, Rui; Coelho, Catarina; Pereira, Pedro; Repici, Alessandro; Macedo, Guilherme
• Is Part Of: Digestive and liver disease. Volume 51:Issue 3(2019)
• Page Start: 364
• Page End: 372
• Publication Date: 2019-03
• Subjects: Acute malignant colorectal obstruction -- Bridge-to-surgery -- Emergent surgery -- Self-expandable metal stent; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2018.11.006
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Objective: Compare efficacy, safety and long-term outcomes of bridge-to-surgery and emergency surgery in acute malignant colorectal obstruction. Methods: Retrospective study of 94 consecutive patients with left-sided acute malignant colorectal obstruction treated with curative intent between 2010–2017. Results: 48 patients underwent stent placement and 46 underwent emergency surgery. Technical and clinical success were 100% and 87%. Laparoscopy and one-staged operation were more frequent in bridge-to-surgery (44% vs 2%, p < 0.001; 73% vs 30%, p < 0.001). Fewer permanent stomas were created in bridge-to-surgery (15% vs 35%, p = 0.013). Overall morbidity was 36%. Immediate and post-procedure stent related-complications occurred in 6% and 13%; surgery-related complications occurred in 28% (bridge-to-surgery: 15% vs emergency surgery: 41%, p = 0.004). No differences were found regarding tumor recurrence, recurrence-free survival and overall survival. R1 resection (HR 47.2, 95% CI:4.1–543.7), number of lymph nodes harvested (HR 0.995% CI:0.8–0.99) and adjuvant therapy (HR 0.195% CI:0.01–0.9) predicted recurrence-free survival; pTMN stage IV (HR 7.3, 95% CI:1.1–47.6), number of lymph nodes harvested (HR 0.90, 95% CI:0.8–0.97), adjuvant therapy (HR 0.1, 95% CI:0.02–0.4) and surgery-related complications (HR 5.3, 95% CI:1.02–27.3) influenced overall survival. Conclusion: Stent placement has a high success, similarly to emergency surgery, being associated with higher primary anastomosis and lower stoma rates. Tumor recurrence rate, recurrence-free survival and overall survival were comparable between groups; surgery-related complications influenced overall survival.